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DrKnowsBest
DrKnowsBest, Doctor
Category: Medical
Satisfied Customers: 1496
Experience:  Family Physician with extra cert in peds and womens health
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I was prescribed amitrypteline tablets to ease pain in my leg. According

Resolved Question:

I was prescribed amitrypteline tablets to ease pain in my leg.
According to the local hospital, i suffered a partial fit/seizure, very scary.
They said that because i had a scar on my brain, it lowered the threshold of having one of these while taking these tablets.
Please comment.
Submitted: 2 years ago.
Category: Medical
Expert:  DrKnowsBest replied 2 years ago.

DrKnowsBest : Could be
DrKnowsBest : Scarring can interrupt electrical impulses enough to cause a seizure
DrKnowsBest : This can be told usually by an eeg
DrKnowsBest : Amitryptiline can increase risk of seizure
DrKnowsBest : It is used all the time for pain, anxiety, depression but could have increased your risk by changing the threshold of electricity in your brain enough for a normal impulse to cause the seizure
Customer:

Do you think that my doctor prescribed this drug without checking my medical history.

DrKnowsBest : Might have but do you have a history of seizure.
Customer:

No.

DrKnowsBest : Ok well then not contraindicated to prescribe just risk of increasing seizure
DrKnowsBest : Warning on prescription not a reason not to
Customer:

Don't understand.

DrKnowsBest : Ok there are some meds that aren't used with certain conditions so if you had a seizure disorder there are some that are contraindicated or not used
DrKnowsBest : There are some that are used "carefully" so if benefits for pain can outweigh risk
DrKnowsBest : I usually let the patient decide this
DrKnowsBest : If you have never had a seizure then very difficult to say there is any fault
DrKnowsBest : There are a lot of meds that can lower seizure threshold or increase risk of seizure, especially pain meds but they are used all the time even in people with risk, just not usually if you already had a seizure disorder
DrKnowsBest : R u there
Customer:

It would appear that checking my records for anything which would cause a siezure should have been a priority, particularly with this drug, or any other.

DrKnowsBest : Many meds have this as a possible risk, it would limit prescribing very much if all possible effects are avoided, I understand your complaint definitely but in most cases the risk is very low and the prescribing of amitryptiline is pretty common so well tested but all meds have some risk or side effects
DrKnowsBest : If you had a seizure disorder like epilepsy it wouldn't have been indicated but with no history your dr probably would not have predicted any problem I usually let patients know of risk and let them decide but this is not what all drs do
Customer:

OK but with a brain scar the risk is somewhat increased,yes?

DrKnowsBest : Yes, if your dr was aware of the prior scar it still would not be contraindicated to prescribe but there are other meds which Amy have been a better choice for sure
Customer:

The brain scar history is in his database so he should have known, yes?

DrKnowsBest : Yes , would be difficult to say it was malpractice as there is not a contraindications unless you have actually had a seizure in the medication prescribing guidelines ...but ... Yes most of us would have chosen differently with an elevated risk
Customer:

Thankyou. The reason for my questions is that i have to inform DVLA of the fit/isiezure as they probably will take my driving licence away for some time, Educated guess is 12 months.

DrKnowsBest : Yeah 12 months but you could have your dr write a letter saying that the med could have increased risk of seizure and maybe they would accept
Customer:

Do you think that i have any case for complaint against my G.P. if DVLA decide to take my licence away.

DrKnowsBest : Unfortunately no since not actually spelled out in prescription guidelines as a contraindication for amitryptiline ...but if your gp writes a letter saying they prescribed a medication that can increase risk of seizure and you get cleared by a neurologist then the deal
DrKnowsBest : Then the dvla will likely not revoke your license
Customer:

Do you think that my G.P. acted irresponsibly having studied the information just provided to you?

DrKnowsBest : Of you can get a letter saying you have controlled the seizure disorder and in this case likely due to medication then there are exceptions to the loss of license rules, I think your gp could have been very thorough and warned you but really the history of a scar on the brain althought increas risk it is so rarely a problem that is not usually considered when prescribing, I understand your frustration and after the fact yes it seems irresponsible but not likely to have changed the prescription in most cases even if he directly looked at that, since several unlikely events have to occur in order to lead to the seizure and since the risk is so low most I would have done is mention it to the patient and told them it was not likely to be a problem but left it up to them, most would have taken the prescription in my practiec
Customer:

When the tablets were prescribed i asked what possible side effects there would be.

Customer:

The reply was maybe drowsiness or dry mouth.

DrKnowsBest : Ok then yes this should have been disclosed but since very rare might not have even thought of it
DrKnowsBest : I have patients on it with a history of seizures for anxiety prescribed yb
DrKnowsBest : By their neurologist, go figure
Customer:

No advice on ffits or siezures.

DrKnowsBest : Yeah probably just mentioned the most common side effects honestly I have never had a patient have a seizure on it and many are on it
Customer:

OK we seem to be getting nowhere fast.

Customer:

Youi seem to be closing ranks if i may say so.

DrKnowsBest : Most of the Migraine meds, psychological meds, pain meds, and neurological meds to treat seizures have a possibility of causing them so usually we mention what youre likely to experience but could say that with increased risk should have been brought up, still hard to pin on him though as so rare
Customer:

The ultimate question is, do i have a case for compensation for a) distress to me and my family b(loss of driving licence if it happens) and

Customer:

c)out of pocket expenses. You will tell me no doubt that i am wasting my time.

DrKnowsBest : I think not worth it I would more try to get the exception to the loss of license as the small risk in the studies for amitryptiline and not having a definite history of seizures you may spend a lot of money trying but not get anywhere
Customer:

Thankyou - I have your advice and will sleep on it. It seems the odds are against me. Long gone are the days of justice when G.P's are protected against anything thrown at them.

DrKnowsBest : Yes true but easy to spend a lot of money on lawyers willing to take it and then get nowhere I'm just letting you know the likelihood of getting anywhere from what I have seen with colleagues with prescriptions for meds with a direct contraindication in a patient used and still get nowhere but maybe settle, without a contraindications for a predicting condition you may have a hard time getting liability
DrKnowsBest : Please press accept if no more questions so we may sign off
DrKnowsBest, Doctor
Category: Medical
Satisfied Customers: 1496
Experience: Family Physician with extra cert in peds and womens health
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